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Going Dutch: Using Social Capital in Health Care

Article · March 1, 2017

Debating every side of every issue is a more fundamental Dutch characteristic than wooden shoes. But with much of the Netherlands below sea level, the Dutch know that at a certain point, they must stop arguing and work together, or the water comes in. To reclaim land from the ocean, the Dutch not only needed financial capital, but also social capital — the ability to collaborate, trust, and adopt shared norms. Those same cultural values enable the Dutch to work together across organizations to produce innovations in health care that might be useful in other countries struggling to improve value.

Perhaps the best-known example is ParkinsonNet, a network of more than 3,000 health care providers who share one goal: to guarantee the best possible care for people suffering from Parkinson’s disease. Elsewhere in the world, diagnosis of this disease means the start of an excruciating process to find clinicians who can help patients with its many manifestations. Frequently, these therapists are not focused solely on Parkinson’s disease, and do not routinely work together.

But in the Netherlands, every patient with Parkinson’s can receive care from a team drawn out of ParkinsonNet’s geographically based, multidisciplinary networks of allied health professionals. These personnel — mainly nurses and physical, occupational, and speech therapists, as well as neurologists — pay an annual membership fee (€115) and commit to using ParkinsonNet evidence-based guidelines.

After launching in 2004 with one small regional network, the model reached full nationwide coverage after 6 years and is now expanding abroad, for example in Norway and to Kaiser Permanente in the United States. Today, 70% of the 50,000 patients with Parkinson’s in the Netherlands use ParkinsonNet therapists, and results have shown better quality, lower costs, and greater provider satisfaction.

Another example of social capital in action is Buurtzorg (known in the United States as “neighborhood nursing”), founded in 2006 by a small team of professional nurses who were dissatisfied with the traditional delivery of home care. The community-based nursing teams concept is proving that more trust within the organization means that overhead expenses can be reduced. Buurtzorg has no administrative staff; when self-steering teams work together with the patient to find care solutions, management personnel are not needed for personnel who do not need management.

Patient satisfaction is extremely high, and Buurtzorg has been awarded “best employer” in the Netherlands five times in a row. Buurtzorg is now the fastest growing home care organization in the Netherlands; between 2011 and 2014, revenues doubled.

Dutch General Practitioners, which is the cornerstone of Dutch health care and the first system entry for all patients, further illustrates the development of trust on a larger scale. In the past few years, GPs have been given expanded responsibilities, such as care management for patients with chronic diseases. In response, a small group of GPs raised their concerns about three major points in health policy by literally nailing a manifesto to the door of the Dutch Ministry of Health. They sought more equal positions for GPs versus insurance companies; possibilities to cooperate with one another in care for their patients; and a reduction of the daunting bureaucracy of quality measure collection, which had been interpreted as lack of trust.

Within 6 weeks, the manifesto was signed by two-thirds of Dutch GPs, and within 3 months, a large conference was held on the GP role, with all stakeholders present, including insurance companies, national health authorities, and the Minister of Health. Workgroups formed plans of action to address the issues in the manifesto, some of which were implemented just 9 months later.

In all three examples, social capital has been key to success. Buurtzorg demonstrates that self-steering teams can create strong social capital, fostering efficacy and efficiency. ParkinsonNet and the GP collective show the benefits of externally “bridging” social capital.

It may be that the ingrained habit among the Dutch of consultation and cooperation (also known as poldermodel) facilitates the building of social capital in these examples. But there is no reason that the opportunities created by social capital cannot be realized in other countries and in organizations that are focused on building trust and cooperation among providers.

Over the next decade, health care providers will encounter an increase in patients with complex combinations of problems. There will surely be endless disputes over how to pay for the care that they need. Part of the answer may be going Dutch — and using social capital to build a high-performing, sustainable health care system.

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